Translating Research into Practice: Glycemic Control of Critically Ill Patients

Paper

Saturday, 22 July 2006

This presentation is part of : Translating Research into Practice

Sue Sendelbach, RN, PhD, CCNS, FAHA, Nursing, Abbott Northwestern Hospital, Minneapolis, MN, USA, Jessica M. Swearingen, PharmD, BCPS, Pharmacy, Abbott Northwestern Hospital, Minneapolis, MN, USA, and Robert Miner, MD, Medicine, Abbott Northwestern Hospital, Minneapolis, MN, USA.

Learning Objective #1: Describe the literature base of glycemic control of critically ill patients
Learning Objective #2: List two methods of incorporating the American College of Endocrinology recommendations for glycemic control of critical ill patients into practice

Background: The benefits of tight glycemic control in critically ill patients have been well established in the literature and include decreases in mortality, organ dysfunction and length of stay.
Purpose: The purpose of this evidence based project was two-fold: 1) to standardize the IV intensive insulin protocol; and 2) to decrease the goal blood glucose range to values recommended by the American Society of Endocrinologists. The study targeted patients who were both hyperglycemic and critically ill.
Description: An interdisciplinary group, consisting of a clinical nurse specialist, a critical care pharmacist, staff nurses from the critical care units, an endocrinologist and hospitalist, convened to assess current blood glucose management, develop and implement an intensive insulin therapy protocol and evaluate the impact of the protocol on glycemic management in critically ill patients. The primary objective was to achieve and maintain blood glucose levels between 90-120 mg/dL Due to the complexity of the protocol, a computer program was developed to aid nurses in calculating insulin dose changes and to decrease risk for error. The protocol calculates insulin dose changes based on the patient’s last 2 blood glucose values. The computerized program determines the how fast the blood glucose is rising or falling and considers how far the patient’s blood glucose is from the goal range, then calculates a percentage change in insulin requirements. Nurses and pharmacists were educated to ensure the rationale for the protocol and tight glycemic control was understood.
Evaluation and Outcomes: The percentage of blood glucose values within the goal range post-protocol implementation increased in the cardiovascular surgical intensive care unit (CV-ICU) and the cardiac care unit (CCU), by 71% and 78%, respectively while hypoglycemic episodes (blood glucose <60 mg/dL) were 0.6% (CV-ICU) and 1.2% (CCU) pre-implementation and were 0.7% (CV-ICU) and 0.7% (CCU) post-implementation.

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